Lombardi Carolina, Parati Gianfranco, Cortelli Pietro, Provini Federica, Vetrugno Roberto, Plazzi Giuseppe, Vignatelli Luca, Di Rienzo Marco, Lugaresi Elio, Mancia Giuseppe, Montagna Pasquale, Castiglioni Paolo
Center for Sleep Disorders, Department of Neurological Sciences, University of Bologna, Bologna, Italy.
J Sleep Res. 2008 Sep;17(3):263-70. doi: 10.1111/j.1365-2869.2008.00659.x. Epub 2008 May 20.
Sleep-related breathing disorders are common causes of excessive daytime sleepiness, a socially and clinically relevant problem. Mechanisms responsible for daytime sleepiness are still largely unknown. We investigated whether specific alterations in autonomic cardiac modulation during sleep, commonly associated with sleep-related breathing disorders, are related to excessive daytime sleepiness. Fifty-three patients with sleep-related breathing disorders underwent nocturnal polysomnography. Excessive daytime sleepiness was diagnosed as a Multiple Sleep Latency Test response less than or equal to 600 s. We explored the relation of excessive daytime sleepiness, objectively determined, with indices of autonomic cardiac regulation, such as baroreflex sensitivity and heart rate variability, with polysomnographic indices of the severity of sleep-related breathing disorders and with quality of sleep. Patients with excessive daytime sleepiness, when compared with patients without, had significantly lower baroreflex sensitivity and significantly higher low-to-high frequency power ratio of heart rate variability during the different stages of nocturnal sleep. By contrast, no differences were found in indices quantifying the severity of sleep-related breathing disorders or sleep quality. We demonstrated that excessive daytime sleepiness is accompanied by a deranged cardiac autonomic control at night, the latter probably reflecting autonomic arousals not detectable in the EEG. As abnormal autonomic regulation is also known to be associated with increased cardiovascular risk, a possible relation between excessive daytime sleepiness and cardiovascular events in patients with sleep-related breathing disorders deserves to be investigated in future studies.
与睡眠相关的呼吸障碍是导致日间过度嗜睡的常见原因，这是一个具有社会和临床相关性的问题。导致日间嗜睡的机制在很大程度上仍不明确。我们研究了睡眠期间自主心脏调节的特定改变（通常与睡眠相关呼吸障碍有关）是否与日间过度嗜睡有关。53例患有睡眠相关呼吸障碍的患者接受了夜间多导睡眠监测。日间过度嗜睡被诊断为多次睡眠潜伏期试验反应小于或等于600秒。我们探讨了客观确定的日间过度嗜睡与自主心脏调节指标（如压力反射敏感性和心率变异性）、睡眠相关呼吸障碍严重程度的多导睡眠图指标以及睡眠质量之间的关系。与无日间过度嗜睡的患者相比，有日间过度嗜睡的患者在夜间睡眠不同阶段的压力反射敏感性显著降低，心率变异性的低频与高频功率比显著升高。相比之下，在量化睡眠相关呼吸障碍严重程度或睡眠质量的指标方面未发现差异。我们证明，日间过度嗜睡伴有夜间心脏自主控制紊乱，后者可能反映了脑电图中无法检测到的自主觉醒。由于已知异常的自主调节也与心血管风险增加有关，睡眠相关呼吸障碍患者日间过度嗜睡与心血管事件之间的可能关系值得在未来研究中进行调查。
